Review & Reassess

The Reviews Workflow process is used for 3 month, 12 month or ad-hoc Reviews of CHC cases.

As per the National Framework the outcome of an NHS Continuing Healthcare review will determine whether:

a) The individual’s needs are being met appropriately, and

b) Whether eligibility should be reconsidered through reassessment for NHS Continuing Healthcare.

There are three potential outcomes to the Reviews Workflow process:

a) No change needed existing in care package

b) Changes to existing care package

c) Change in individual’s needs resulting in the need to reassess for CHC funding

Workflow Stages

1. Assign Caseworkers

It is mandatory to assign a Case Reviewer e.g. CHC nurse who will conduct the Review. Once a user has been selected click Progress to trigger next stage “Schedule Review”.

2. Schedule Review

Enter date/time/location of planned review.

Invite participants. The Case Reviewer is automatically brought through from the previous stage in the process.

Click on “Create notification” to call the email template to the screen:

Click on the Save button to save content of email that will be sent to advise review will be taking place.

Click on Progress and then email is sent with review details:

On the day of the Review the Reviewer can click on the Reviews tab on the case:

The user clicks on the meeting code to access the digital review:

The user clicks on the “Open Review” button to access the digital review form:

The user clicks on the “Connect” button:

All relevant case data is pre-populated on to the digital Review form.

Data from the previous DST or Review is displayed in read-only alongside the fields on the Review form that the user has to complete:

Against each domain the user can see the “level of need” scores, the paragraphs previously chosen and comments recorded:

The user can then record the level of need during the review and add any comments:

Every domain has to be reviewed.

Once all domains have been reviewed the Recommendation page displays a summary of the level of need scores.

The digital Review form can then be submitted.

The Review status is then changed to “Complete” and this is displayed on the Reviews tab:

This triggers the next step in the Workflow process “Check care plan needs amending”.

Check Care Plan Needs Amending

This is a decision stage in the Workflow process.

If the user clicks on the Progress button underneath “No” then the next stage is “Is there evidence of change in needs potentially affecting eligibility” is triggered.

If the user clicks on the Progress button underneath “Yes” the next stage “Amending Care Pan” is triggered.

Amending Care Plan

Once the care plan has been amended the user clicks on the Progress button to complete the stage in the process. This triggers the “Is there evidence of change in needs potentially affecting eligibility” stage.

Is there evidence of change in needs potentially affecting eligibility?

Clicking on “Progress” underneath “Yes” triggers the “Reassess” Workflow process.

Clicking on “Progress” underneath “No” completes the Workflow process.

Reassess Workflow

The first stage in the Workflow process is “Assign to Locality Team” and then the process follows all the same stages that are in the “Checklist to MDT” Workflow process from this point onwards enabling a full reassessment of eligibility for NHS Continuing Healthcare.